Your Insurance: UnitedHealthcare

UnitedHealthcare (UHC) settled a class-action lawsuit alleging that it failed to cover lipedema adequately. It issued a coverage policy for liposuction for lipedema that is effective as of October 1, 2021. While this policy covers liposuction for lipedema, it does not cover skin excision and features strict conservative measure requirements. UHC also tends to use provisions in employer policies to deny coverage even though it has a corporate medical policy. Like the other insurance companies that settled the lawsuit, UHC has not made it simple or easy to get covered.

We Can Get UHC Members Fully Covered

Even with the strict UHC policy, we have helped almost 100 Coverlipedema.com members with UHC plans get fully covered for liposuction for lipedema. Although skin excisions and panniculectomy or abdominoplasty for lipedema are not explicitly covered in the UHC lipedema coverage policy, we have also been able to get them covered. UHC also tends to use provisions in employer policies to deny coverage even though it has a coverage policy. We have been able to overcome these provisions, too.

How We Help UHC Members Get Covered

Because of the UHC lipedema policy, submitting a strong prior authorization request is necessary. The Coverlipedema.com process shows you how to obtain all the required documentation, and we carefully review it to ensure nothing is missing or will cause issues with approval. We then add additional support to your prior authorization package so a UHC reviewer understands that you meet all the coverage requirements. Even years after the settlement, UHC has not adequately trained its staff on lipedema, and some of its medical directors still believe that liposuction is a cosmetic treatment for lipedema. We can often help Coverlipedema.com members avoid being denied by contacting our UHC plan contacts, some of whom we have worked with for over five years. We have helped almost 100 Coverlipedema.com members get fully covered with UHC for liposuction. In addition to getting members covered, we also help ensure sufficient time to complete an entire surgery plan.

Appeals are Almost Always Needed with UHC

Because UHC does not cover skin excision, panniculectomy, or abdominoplasty for lipedema, Coverlipedema.com members who have these in their surgery plans must appeal to get coverage. Fortunately, we have won coverage through a three to four-month appeal process for dozens of our members. The appeal process is fraught with concerns about getting a fair review, and we do not recommend doing this without help. We have been fighting UHC for years and keep extensive data that win appeals. We are constantly updating our arguments to stay one step ahead of UHC attempts to limit coverage.

Choosing an Insurance-friendly Surgeon is Important for UHC

It’s far better to work with a plastic surgeon that we have vetted and recommend for being insurance-friendly. However, many plastic surgeons treating lipedema are not in-network with insurance but are insurance-friendly. They will not ask for full cash payment upfront and will allow you enough time for us to help you get a network exception, which is required before getting a single case agreement. UHC, despite the lawsuit, has not updated its fee schedules for lipedema but tends to pay surgeons fairly. In our experience, it drags out contract negotiations, leading to delays of care. Depending on your state and type of plan, we have ways to compel UHC to move faster.

Network exceptions and single-case agreements are not easy

Network exceptions and single-case agreements are unusual and very hard for someone to get on their own, even with the help of a surgeon. Because we have helped hundreds of Coverlipedema.com members get out-of-network coverage nationwide with different plastic surgeons, we have access to data, arguments, and contacts at UHC plans and state and federal regulators that others do not have.

UnitedHealthcare Remains a Challenge

Although UHC has a coverage policy, getting safe, effective, and fully covered lipedema surgery remains a challenge for lipedema patients who have UHC insurance plans. However, with the knowledge and advocacy of Coverlipedema.com, coverage is very possible.